Villanueva Institute of Pain and Spine
Chronic Back Pain Treatment in Burbank, CA
Chronic back pain can quietly affect nearly every part of your daily routine. This condition may have built slowly from arthritis, disc problems, spinal stenosis, muscle strain, nerve irritation, prior surgery, or years of wear on the spine. By the time pain has lasted for months, the real question is usually not just “Why does my back hurt?” It is “What is causing my pain now, and what can we do about it?”
I am Dr. John Villanueva, double board-certified in PM&R and interventional pain management at Villanueva Institute of Pain and Spine (VIPS). When I evaluate chronic back pain, I look at your symptoms, movement, imaging, exam findings, nerve function, prior treatments, and the parts of life that pain has started to limit.
At VIPS, chronic back pain care starts with finding the most likely pain source. I will explain what appears to be coming from the spine, joints, discs, nerves, muscles, sacroiliac joint, or another structure, then talk through the treatment options that fit your situation.
If you are looking for chronic back pain treatment in Burbank, CA, call VIPS at (818) 669-8895 or request an appointment online. We are located in Burbank and see patients from Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.
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What Is Chronic Back Pain?
Back pain is usually considered chronic when it lasts longer than expected, keeps returning, or continues to interfere with daily function for several months. Chronic back pain can affect the low back, mid-back, upper back, or the areas where the spine meets the pelvis.
Some patients have mostly aching or stiffness in the back itself. Others have pain that travels into the buttock, hip, groin, leg, foot, shoulder blade, ribs, or chest wall. Some also have numbness, tingling, burning, weakness, or cramping, which can suggest nerve involvement.
Chronic back pain is a symptom with many possible causes, which is why a thorough evaluation matters. Two patients can both say they have “low back pain,” but one may have facet joint pain, another may have sciatica, another may have sacroiliac joint pain, and another may have vertebrogenic pain coming from damaged endplates inside the spine.
Common Chronic Back Pain Symptoms
Chronic back pain can feel different from person to person. How it behaves often gives important clues about the source.
Patients often describe:
- Deep aching or stiffness in the low back
- Sharp pain with bending, lifting, twisting, or standing
- Pain that worsens after sitting too long
- Pain that worsens with walking or standing
- Relief when leaning forward or sitting down
- Pain that travels into the buttock, hip, groin, leg, or foot
- Burning, tingling, numbness, or electric pain
- Back spasms or tightness
- Pain after prior spine surgery
- Pain that interrupts sleep
- Trouble walking, exercising, working, driving, or doing household tasks
Symptoms can also overlap. The place that hurts is not always the only source of the problem. Back pain can involve joints, discs, nerves, muscles, ligaments, hips, posture, prior injuries, or prior surgery. I look at the full pattern before recommending treatment.
Common Causes of Chronic Back Pain
Chronic back pain can come from several structures in and around the spine. Sometimes one source is obvious. Often, more than one issue contributes.
Degenerative Disc Disease
Degenerative disc disease refers to age-related or wear-related changes in the spinal discs. Over time, discs can lose height, hydration, and shock absorption. Some patients feel deep low back pain, stiffness, or pain that worsens with sitting, bending, or lifting.
Disc changes are common on imaging, so the MRI has to be interpreted carefully. The important question is whether the disc findings match your symptoms and exam.
Herniated Disc
A herniated disc occurs when disc material pushes outward and irritates nearby nerves. This can cause back pain, leg pain, sciatica, numbness, tingling, burning, or weakness.
Some herniated discs improve with time and conservative care. Others continue to irritate a nerve and may require more targeted treatment, such as an epidural steroid injection or surgical evaluation depending on the severity.
Sciatica and Radiculopathy
Sciatica is pain that travels along the sciatic nerve pathway, often from the low back into the buttock, back of the thigh, calf, or foot. Radiculopathy means a spinal nerve root is irritated or compressed.
This type of pain may feel sharp, shooting, electric, burning, or numb. It may worsen with sitting, bending, coughing, walking, or certain positions. If weakness is present, the evaluation becomes more urgent.
Spinal Stenosis
Spinal stenosis means the spinal canal or nerve openings have narrowed. In the low back, this can cause leg heaviness, cramping, numbness, tingling, or weakness with standing and walking.
Many patients with lumbar spinal stenosis feel better when sitting or leaning forward. They may lean over a shopping cart because that position gives the nerves more room. Treatment depends on what is causing the narrowing and how much it limits walking.
Facet Joint Pain
Facet joints are small joints in the back of the spine that help guide motion. Arthritis or irritation in these joints can cause deep, aching, mechanical back pain.
Facet-related pain often worsens with standing, twisting, bending backward, or getting up after sitting. Medial branch blocks, facet joint injections, or radiofrequency ablation may be discussed when the pattern fits.
Sacroiliac Joint Pain
The sacroiliac joint, or SI joint, sits where the spine meets the pelvis. SI joint pain can feel like low back pain, buttock pain, hip pain, groin pain, or upper thigh pain.
It may worsen with walking, stairs, standing on one leg, rolling in bed, or getting in and out of a car. SI joint pain can also develop or become more noticeable after lumbar fusion or changes in walking mechanics.
Vertebrogenic Low Back Pain
Vertebrogenic pain comes from damaged or inflamed vertebral endplates, the areas where the spinal discs meet the vertebral bones. This pain is often deep and central in the low back and may worsen with sitting, bending forward, or lifting.
When MRI shows Modic changes and the symptoms fit, basivertebral nerve ablation, also known as the Intracept® procedure, may be discussed.
Muscle and Myofascial Pain
Muscles can become painful from injury, guarding, posture, repetitive strain, weakness, or the body’s attempt to protect an irritated spine. Some patients develop trigger points, which are tight, tender bands of muscle that can refer pain into nearby areas.
Muscle pain can be real and significant, especially when it keeps the back in a cycle of tightness, limited motion, and fear of movement.
Pain After Spine Surgery
Back pain that continues or returns after spine surgery deserves a careful review. The pain may come from nerve irritation, scar tissue, recurrent stenosis, facet joints, SI joints, adjacent segment changes, hardware issues, or a new pain generator.
The first step is understanding what changed after surgery and what the pain pattern looks like now.
When Back Pain Needs Prompt Medical Attention
Some back pain symptoms should be evaluated urgently; seek emergency care if you develop new loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening weakness, fever with severe back pain, unexplained weight loss, pain after major trauma, or severe pain with a history of cancer or infection risk.
For ongoing pain that is stable but limiting your life, a pain management consultation can help identify the likely source and next step.
How Chronic Back Pain Is Diagnosed
Diagnosing chronic back pain starts with listening carefully. I want to know when the pain began, where it starts, where it travels, what makes it worse, what eases it, what you have already tried, and what pain has stopped you from doing.
During your exam, I may check posture, gait, range of motion, strength, reflexes, sensation, tenderness, nerve tension signs, hip motion, SI joint signs, and how your pain changes with movement.
Testing may include X-rays, MRI, CT scan, EMG/NCS testing, or other studies depending on your symptoms. Imaging can be helpful, but it has to be interpreted in context. Many people have arthritis, disc changes, or degeneration on imaging without those findings being the main pain source.
Whenever possible, I prefer to review the actual images, not only the written report. Reports are useful, but the images often show details that affect the treatment plan.
Chronic Back Pain Treatment Options
Chronic back pain treatment should match the diagnosis. A pinched nerve, arthritic facet joint, stenosis pattern, SI joint problem, vertebrogenic pain pattern, and muscle-driven pain pattern all require different planning.
Physical Therapy and Rehabilitation
Physical therapy can help improve strength, flexibility, walking tolerance, posture, mechanics, and confidence with movement. As a PM&R physician, I pay close attention to how pain affects function.
The plan may include core strengthening, hip mobility, gait work, posture training, stretching, home exercise, pacing strategies, or gradual return to activity. For many patients, rehabilitation is also where they begin trusting their back again.
Epidural Steroid Injections
Epidural steroid injections may help when chronic back pain is tied to irritated or inflamed spinal nerves. This can happen with sciatica, radiculopathy, herniated discs, spinal stenosis, or foraminal narrowing.
The injection delivers anti-inflammatory medication near the affected nerve area. Your response can help clarify whether nerve inflammation is a meaningful part of your pain.
Medial Branch Blocks and Facet Joint Injections
Medial branch blocks and facet joint injections can help evaluate pain coming from the small joints of the spine. These procedures are often discussed when back pain feels mechanical, stiff, deep, or worse with standing, twisting, or bending backward.
If diagnostic medial branch blocks give strong temporary relief, radiofrequency ablation may be a reasonable next step.
Radiofrequency Ablation
Radiofrequency ablation, often called RFA, uses controlled heat to quiet selected nerves that carry pain signals from arthritic or irritated joints. For properly selected patients with facet-related back pain, RFA can provide longer-lasting relief than a temporary injection.
RFA is chosen only after the diagnostic process supports the target.
Sacroiliac Joint Injections
A sacroiliac joint injection can help when pain appears to come from the SI joint. This may be useful for low back, buttock, hip, groin, or upper thigh pain that matches an SI joint pattern.
The response to the injection can also help confirm whether the SI joint is contributing to the problem.
Trigger Point Injections
Trigger point injections can help when tight, painful muscle bands in the back, hips, or surrounding areas are contributing to pain. These injections may make movement, stretching, posture work, and physical therapy more tolerable.
PRP and Regenerative Medicine
PRP and other regenerative medicine options may be discussed for certain joint, tendon, ligament, muscle, or spine-related pain patterns. These treatments are chosen based on diagnosis, imaging, severity, prior response to care, and realistic expectations.
Basivertebral Nerve Ablation
Basivertebral nerve ablation, also known as the Intracept® procedure, may be an option when chronic low back pain appears to be vertebrogenic. This means the pain is coming from damaged vertebral endplates, often with Modic changes on MRI.
mild® Procedure
The mild® Procedure may be discussed for certain patients with lumbar spinal stenosis caused in part by thickened ligament tissue. It is designed for patients whose symptoms worsen with standing or walking and improve with sitting or leaning forward.
The procedure removes a small amount of tissue that is contributing to narrowing in the spinal canal.
Spinal Cord Stimulation
Spinal cord stimulation may be considered for certain patients with chronic nerve-related back or leg pain, especially when symptoms have continued despite medication, therapy, injections, prior surgery, or other appropriate care.
Patients begin with a temporary trial before any permanent implant is discussed.
Medication Management
Medication can help when back pain is making it difficult to sleep, move, work, or participate in therapy. Depending on the diagnosis, we may discuss options to reduce inflammation, calm nerve-related symptoms, ease muscle spasm, or make daily activity more tolerable.
I choose medication carefully based on your diagnosis, health history, current prescriptions, and how you have responded to treatment in the past. Medication works best when it supports the larger plan rather than becoming the whole plan.
Surgical Referral When Appropriate
Some back pain requires a surgical opinion. This may apply when imaging shows severe nerve compression, progressive weakness, instability, fracture, infection, tumor, severe spinal stenosis, or another structural problem that needs surgical evaluation.
Good Candidates for Chronic Back Pain Treatment
You may benefit from a chronic back pain evaluation if pain has lasted for months, keeps returning, or has not improved enough with rest, medication, therapy, injections, or prior procedures.
Patients often come in with:
- Low back pain, mid-back pain, or upper back pain
- Pain that travels into the buttock, hip, groin, leg, or foot
- Numbness, tingling, burning, cramping, or weakness
- Pain with sitting, standing, walking, bending, lifting, or twisting
- Back pain after surgery
- Back pain from arthritis, disc changes, spinal stenosis, or sciatica
- Difficulty sleeping because of back pain
- Reduced ability to work, exercise, drive, travel, or care for family
- Imaging that shows degeneration, stenosis, herniated disc, arthritis, or other spine findings
- A need for a clearer explanation before choosing the next step
You do not need to know which treatment you need before coming in. The consultation is where we connect the symptoms, exam, imaging, and goals.
How I Evaluate You Before Recommending Treatment
Before recommending treatment, I want to understand the pain source as clearly as possible. That means looking beyond the label of “back pain” and studying the pattern.
During your consultation, I may review your prior records, medications, imaging, procedure history, and surgical history. I perform a physical and neurological exam and may recommend EMG/NCS testing when nerve or muscle function needs closer evaluation.
I also ask about the life part of the problem. Can you sit through dinner? Walk the dog? Stand long enough to cook? Work without lying down afterward? Drive without shifting constantly? Sleep through the night? Return to the gym? Those details help define whether treatment is working.
Back pain treatment should be measured by function, mobility, and quality of life, not pain level alone.
Why Choose VIPS for Chronic Back Pain Treatment?
Double board-certified expertise
I am double board-certified in PM&R and interventional pain management. My PM&R training helps me evaluate movement, function, rehabilitation, strength, and nerve symptoms. My interventional training allows me to perform targeted spine procedures when they fit the diagnosis. I am proud to bring the additional expertise of a Certified Life Care Planner to my work. Along with my double-board certifications, this specialized training enables me to assess the long-term medical, rehabilitation, and future care needs of individuals with complex injuries and disabilities.
A careful diagnostic process
I review your symptoms, exam findings, imaging, prior care, and daily limitations before recommending treatment.
Image-guided procedures when appropriate
Many spine injections and procedures are performed with fluoroscopy or ultrasound guidance. The guidance method depends on the target, anatomy, safety, and clinical need.
A full view of back pain
Chronic back pain can come from discs, nerves, facet joints, sacroiliac joints, muscles, vertebral endplates, stenosis, prior surgery, or several sources at once. I take time to sort through that pattern.
A broad treatment toolkit
Care may include rehabilitation, medication management, epidural steroid injections, medial branch blocks, facet joint injections, radiofrequency ablation, SI joint injections, trigger point injections, PRP, Intracept®, mild®, spinal cord stimulation, EMG/NCS testing, or surgical referral.
Clear guidance about next steps
I will explain what appears to be driving your pain and why a specific treatment option fits. If another specialist should be involved, we will talk through that directly.
A warm, unhurried experience in Burbank
Many patients with chronic back pain have been through years of appointments, imaging, and partial answers. I want you to leave with a clearer understanding of what may be happening and what we can do next.
What Happens During Chronic Back Pain Treatment?
Before any procedure, I explain what we are targeting, how the treatment works, what you may feel afterward, and how we will judge the response. Some patients need treatment in stages. We may start by identifying the strongest pain generator, then build the rest of the plan around your response.
Your treatment depends on the source of pain:
- For nerve-related pain, treatment may involve an epidural steroid injection or selective nerve root block.
- For facet-related pain, it may involve medial branch blocks, facet joint injections, or radiofrequency ablation.
- For sacroiliac joint pain, the target is the SI joint.
- For muscle-related pain, trigger point injections and rehabilitation may be helpful.
- For vertebrogenic low back pain, basivertebral nerve ablation may be discussed.
- For stenosis-related walking difficulty, the mild® Procedure may be considered.
- For chronic nerve pain after surgery or other long-standing nerve pain patterns, spinal cord stimulation may be part of the conversation.
Chronic Back Pain Treatment in Burbank, CA
VIPS is located in Burbank, CA, in the Magnolia Park neighborhood. The office is designed to feel welcoming and personal, with comfortable seating, warm finishes, and original artwork from patients who are working artists.
This is a place where your story has time to be heard. I live and work in Burbank, and I care about building a practice where patients feel known, respected, and well-informed.
We see patients from Burbank, Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.
Burbank Chronic Back Pain FAQs
To schedule a chronic back pain consultation in Burbank, CA, call (818) 669-8895 or contact VIPS online today. The right care may help you spend less time planning around back pain and more time moving with comfort, confidence, and peace of mind.
What causes chronic back pain?
Chronic back pain can come from degenerative disc disease, herniated discs, spinal stenosis, sciatica, facet joint arthritis, sacroiliac joint pain, vertebrogenic pain, muscle pain, prior injury, prior surgery, or more than one source at the same time.
When should I see a pain management doctor for back pain?
You should consider a pain management evaluation if back pain has lasted for months, keeps returning, travels into the leg, causes numbness or tingling, limits sleep or activity, or has not improved enough with medication, physical therapy, rest, or prior treatment.
Can chronic back pain be treated without surgery?
Yes. Many patients with chronic back pain are treated with nonsurgical options such as physical therapy, medication management, epidural steroid injections, medial branch blocks, facet joint injections, radiofrequency ablation, SI joint injections, trigger point injections, regenerative medicine, or other procedures when appropriate.
Can chronic back pain cause leg pain?
Yes. Chronic back pain can cause leg pain when a spinal nerve is irritated or compressed. This may happen with sciatica, herniated discs, spinal stenosis, foraminal narrowing, or radiculopathy.
What is the difference between back pain and sciatica?
Back pain is discomfort in the back itself. Sciatica usually refers to pain that travels from the low back or buttock into the leg along the sciatic nerve pathway. Sciatica often feels sharp, shooting, burning, electric, or numb.
Can epidural steroid injections help chronic back pain?
Epidural steroid injections can help when irritated or inflamed spinal nerves are contributing to back, buttock, or leg pain. They are often discussed for sciatica, herniated discs, spinal stenosis, foraminal narrowing, or radiculopathy.
How much does chronic back pain treatment cost in Burbank, CA?
The cost of chronic back pain treatment in Burbank can vary depending on the evaluation, imaging, medication plan, therapy, injections, radiofrequency ablation, regenerative medicine, advanced procedures, or specialist referrals involved. During your consultation, my team can help you understand what information may be needed for scheduling, authorization, and cost review.